"BD is a highly recurrent condition, but the psychosocial impact of multiple episodes has rarely been the focus of outcome studies," observe Eduard Vieta (University Clinic Hospital of Barcelona) and team.

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"The majority of such studies have analyzed first- or multiple-episode patients separately, and very few of them have distinguished functional recovery from syndromal remission," they add.

To investigate further, the researchers studied 60 first- and 59 multiple-episode BD patients who participated in a 1-year follow-up study.

Sociodemographic and clinical variables were recorded at baseline. Manic and depressive symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS)-21, respectively, with symptomatic recovery defined as scores of five or less on the YMRS and eight or less on the HDRS-21.

The Functioning Assessment Short Test (FAST) was used to assess functional outcomes.

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Patients with multiple episodes were significantly older than first-episode patients, at 46.7 versus 29.7 years, but there were no significant differences regarding age at onset between the groups, at 29.8 and 28.3 years, respectively. Axis I comorbidity was more prevalent in first- than multiple-episode patients, and first-episode patients also had higher baseline YMRS (29.93 vs 13.07) and HDRS-21 (18.30 vs 12.57) scores.

The researchers found that first-episode BD patients had better overall functioning than those with multiple episodes at both 6 months and 12 months, with overall FAST scores of 15.20 versus 29.11, and 11.26 versus 26.91, respectively. Specifically, first-episode BD patients had higher levels of autonomy, better occupational and cognitive functioning, and a greater capacity to enjoy their relationships and leisure time at both time points compared with multiple-episode patients.

At 6 months, similar rates of symptomatic recovery were observed in first- and multiple-episode patients, at 42.4% and 40.0%, respectively. But at 12 months, symptomatic recovery rates were significantly higher in first-episode patients, at 62.7% versus 44.9%.

The researchers also found that higher levels of depressive symptoms at baseline were significantly associated with poorer functioning at 6 months, particularly in multiple episode patients, but not at 12 months.

Vieta and team conclude: "Our data give support to the model of staging in bipolar disorder, showing that the enduring neurotoxicity of repeated episodes may contribute to sustained impairment in multiple areas of psychosocial functioning."